IDOE Assessment Committee Participant Survey

Created for Nicole Smithers by Nhan Nguyen on 06/20/2019
Indiana Department of Education
Assessment Committee Participant Survey

The Indiana Department of Education (IDOE) is continuing to form committees to work on important assessment-related tasks. Note: Survey results are confidential and used for participant selection purposes only.
Full Name*

PrefixFirst NameLast Name
Work Phone*
Summer Phone*
Work Email*

Confirmation Emailexample@example.com
Summer Email*

Confirmation Emailexample@example.com
Corporation Name and Corporation Number*
School Name and School Number (if applicable)
You have selected "Other", please provide School/Corporation Name/Number*
Principal / Superintendent Name*

First NameLast Name
Principal / Superintendent Email*

Confirmation Emailexample@example.com
License Area (select all that apply)*

Special EducationEnglish Language LearnersHigh AbilityElementary EducationEnglish Language ArtsMathematicsScienceSocial StudiesSchool AdministrationNone of the AboveOther
Interested in assessment committees for the following programs (select all that apply)*

ILEARNI AMISTEP+IREAD-3
Current Role (select all that apply)*

General Education TeacherSpecial Education TeacherInstructional/Title CoachCorporation/Building Administrator
Years of Education-Related Experience

1-23-56-10More than 10
Grade-Level Experience from the last 3 years (select all that apply)*

K12345678High School
Content Area Experience from the last 3 years (select all that apply) *

English/Language ArtsMathematicsHigh School Mathematics (Algebra)ScienceHigh School BiologySocial StudiesHigh School U.S. Government
IDOE Assessment Committee Experience (select all that apply)*

Specifications ReviewPassage ReviewContent ReviewBlueprint DevelopmentBias and Sensitivity ReviewStandard Setting / Cut Score SettingNone of the Above
Total Number of IDOE Committees you have served on
For Diversity Purposes Only
This data is collected for peer review.
Gender*

FemaleMale
Ethnicity (select one)*

HispanicNon-Hispanic
Race (select all that apply)*

American Indian / Alaska NativeBlack or African AmericanAsianHispanic/Latino (of any race)WhiteMultiracial (two or more races)Native Hawaiian or Other Pacific Islander
Should be Empty: